Horton Susan, Adombi Ulrich, Beynon Fenella, Emmanuel-Fabula Mira, Herrick Tara, Kumar Sandeep, Makawia Suzan, Mugo Mercy, Onah Michael, Ruffo Michael, Awasthi Shally, Ba Maymouna, Bohle Leah F, Cicconi Silvia, Langet Hélène, Faye Papa Moctar, Masanja Honorati, Miheso Andolo, Mjungu Deusdedit, Machoki M'Imunya James, Ndiaye Ousmane, Sharma Kovid, D'Acremont Valérie, Wyss Kaspar
School of Public Health Sciences, University of Waterloo, Waterloo, Canada.
Faculté de médecine, Université Cheikh Anta Diop, Dakar, Sénégal.
PLOS Glob Public Health. 2025 Jul 1;5(7):e0004644. doi: 10.1371/journal.pgph.0004644. eCollection 2025.
Introducing pulse oximeters (PO) at primary care facilities can help health workers identify severely ill children who need referral to hospital thereby allowing for improved child clinical outcomes. Adding clinical decision support algorithms (CDSA) can improve adherence to Integrated Management of Childhood Illness guidelines. The current study analyses the costs of introducing PO either with or without an electronic CDSA using an RCT in India and Tanzania and in a pre-post design with an electronic CDSA in Kenya and Senegal. The impact of the intervention is discussed for the RCT (trial registration NCT04910750) and for the pre-post study (trial registration NCT05065320), following SPIRIT guidelines. Economic data were collected in all four countries using questionnaires administered at primary health facilities and referral hospitals and supplemented by information from administrative sources, following CHEERS guidelines. Trained research assistants at the facilities collected data on children enrolled and health outcomes. Net costs per 100 children managed using PO ranged from $16.62 (Kenya, health center) to $70.51 (Tanzania, dispensary), in both cases using CDSA. Senegal was an outlier at $385.45, using PO and CDSA in the smaller postes de santé. Major causes explaining variation included training modality, numbers of sick children attending the facility, and the effect of PO and CDSA on use of antibiotics, diagnostics, and hospitalizations. Standard care (without PO) was associated with fewer severe complications (primarily untimely hospitalizations), at lower cost, in the two countries where effectiveness data are available, India and Tanzania. Scaling up PO use at primary care level nationally could have an important budgetary impact. Findings suggest ways that costs could potentially be reduced. However, hospitalization costs borne by households may affect both household and provider behavior and limit the potential clinical benefits of pulse oximetry.
在基层医疗机构引入脉搏血氧仪（PO）有助于医护人员识别需要转诊至医院的重症儿童，从而改善儿童的临床结局。添加临床决策支持算法（CDSA）可提高对《儿童疾病综合管理指南》的依从性。本研究采用随机对照试验（RCT），分析了在印度和坦桑尼亚引入带或不带电子CDSA的PO的成本，并在肯尼亚和塞内加尔采用前后对照设计分析了引入电子CDSA的成本。按照《标准方案条目：建议和解释》（SPIRIT）指南，讨论了RCT（试验注册号NCT04910750）和前后对照研究（试验注册号NCT05065320）的干预效果。按照《卫生经济评价报告规范》（CHEERS）指南，通过在基层医疗机构和转诊医院发放问卷，并辅以行政来源的信息，收集了所有四个国家的经济数据。各机构经过培训的研究助理收集了纳入儿童的数据和健康结局。在使用CDSA的情况下，每管理100名使用PO的儿童的净成本从16.62美元（肯尼亚，健康中心）到70.51美元（坦桑尼亚，诊疗所）不等。塞内加尔是个例外，在较小的卫生站使用PO和CDSA时，成本为385.45美元。造成差异的主要原因包括培训方式、到该机构就诊的患病儿童数量，以及PO和CDSA对抗生素使用、诊断和住院的影响。在有有效性数据的印度和坦桑尼亚这两个国家，标准护理（不使用PO）导致的严重并发症较少（主要是住院不及时），成本也较低。在全国基层医疗层面扩大PO的使用可能会产生重大预算影响。研究结果提出了可能降低成本的方法。然而，家庭承担的住院费用可能会影响家庭和医疗机构的行为，并限制脉搏血氧测定的潜在临床益处。
